The most environmentally friendly inhaler is the one that the patient can, will and does use

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Individuals may be interested in the carbon footprint of their inhaler treatment which should be considered during review.

Changes should only be made if effectiveness, safety or adherence is not compromised and this should be managed on a case-by-case basis, using a shared decision-making approach.

Changes should not be made without consulting the patient - the NICE: inhalers for asthma prescribing decision aid can be a useful aid for this process.36

Switching inhalers from MDIs to DPIs could result in the same amount of carbon saving as planting seven trees. (Based on one year of treatment in a person with good control of asthma, using no more than three doses of SABA per week and a regular preventer).

The most important factor in choosing an inhaler device is that the individual can use the inhaler properly.6 

It is essential that reviews are timely to ensure control of their condition is maximised, and inhalers are prescribed and used appropriately, checking adherence to therapy.

Poor control of asthma leads to over-reliance on reliever inhalers and Salbutamol MDI alone accounts for 66% of the total carbon footprint from inhalers.29

Through clinician review and improved management of asthma and COPD, we can improve outcomes for patients, reduce salbutamol use and reduce carbon emissions from inhalers.


Good asthma control is better for your patient and the environment.


  • Local formularies should be updated to highlight and promote lower CO2 emission inhalers and ScriptSwitch can be used to promote environmentally friendly prescribing messages, particularly when prescribing for new patients.
  • Health Boards should consider public advertising campaigns to promote environmentally friendly prescribing and encourage individuals to ask prescribers about this at their review.